1918 Hickory Ln RES19-0182 Interior Remodel RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH RES19-0182
800 SEMINOLE ROAD ISSUED: 6/18/2019
ATLANTIC BEACH. FIL 32233 EXPIRES: 12/15/2019
F—
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies,or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1918 HICKORY LN RESIDENTIAL ALTERATION INTERIOR REMODEL $25422.00
RESIDENTIAL
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1720201314 SELVA MARINA UNIT
12B
COMPANY: ADDRESS: CITY: STATE: ZIP:
HORN BUILDERS INC 12215 St. Johns Industrial Parkway Jacksonville FL 32246
North
OWNER: ADDRESS: CITY: STATE: ZIP:
BROWN LORRAINE 1918 HICKORY LN ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $180.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $90.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $4.OS
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.701
Issued Date:6/18/2019 1 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
-5445 RF5�,19 (D� FDZ
tlantic Beach, Florida 32233
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed
City web-site: hftp://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
1�) Department review required Ye ' No
Property Address: R) fA( o_t�_o iz_(j Ll
f ilding_-)
Applicant: FF)o i � A C rs oning
Tree Administrator
Project: Reft-No d Public Works
es, Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Review or Receipt
Other Agency Review or Permit Required of Permit Verified By Date
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: &Approved. ElDenied. E]Not applicable
(Circle one.) Comments:
(�3
PLANNING &ZONING Reviewed by: Date: 6-
TREE ADMIN. Second Review: FlApproved as revised. DDenied. V ONot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ElDenied. E]Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
OFFICE COPY
Building Permit Application Updated 1019118
City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: 0/ '9 & Permit Number: Cc St Z_
Legal Description L o—r— 4; _,-i 1�I-VA jU/VJZ;4,1.+ JJAJ f-I tQ-13_RE#
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ONew OAddition Ateration Xepair ElMove E]Demo EIPooI E]Window/Door
• Use of existing/proposed structure(s): OCommercial gesidential
• If an existing structure,is a fire sprinkler system installed?: Dyes *0
• Will tree(s)be removed in association with proposed proiect? E]Yes(must submit separate Tree Removal Permit) XN 0
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Describe in clet e ty e of Aork to be performed: rN"LACa -TJ A I V""I IfY AA�f) 5tIC'UAR 6A)1:1-C 1 A
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-7-16 J; — -5&,P414-7i A)&
Imp- a4_;Lj�Vk :50r- -i 1 0 /L-t I
Florida Product Approval# A�ZA for multiple products use product approval form
Property Owner Information
N a m e &_&;9!9- A, 9 0 IJA) Address 1!7/R' 14;en,�oP7V LAAJ4-
City J4-7LAAj7;4f_ State Zip 3 J�4-3 3 —Phone q q/
E-Mail I-ri a t,- f3 g�c C" �L 4)4:;�� - 4;,eq A
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company Qualifying Agent
Address llollS -_,�Z -19#ysk5 Zosj0U!;7 02"Y A;i City ::TkLj4,$cA)u)11Li. State r-L Zip �3j,2&j
Office Phone !ye Ll- 2 q.2 - _�2 Z 6 0 Job Site Contact Number 16 4-6'73 —1-f S6,6
State Certification/Registration# (�,6 &591 6�2 E-Mail (f-
Architect Name&Phone# UJI
Engineer's Name&Phone# A)
Workers Compensation Insurer,4,Ua4;"Wy 13W1=jagjJe, *j54)A#W4�dOR Exempt Ei Expiration Date 6, '3 16%
Cn
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or instal latiott has., -i Z
I . < 0
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulatipe U Z -
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGN_e,,,: < 0 t:
,,- pi - 0
WELLS,POOLS, FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements ojjhll;!U d-- Iw-
o 0
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,1r)d(J f3
there may be additional permits required from other governmental entities such as water management districts,state agencie
federal agencies. z Z
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OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all. -J W
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applicable laws regulating construction and zoning. t= Z
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WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 0 LU
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RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND,_ Lu 0
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TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE Li (n W 3:
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RE G YO�!"OTICE OF COMMENCEMENT. LU >
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L-1' (5 rgnature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me this.21 dayof Signed and sworn to(or affirmed)before me this 2-.Tdayof
r_1 rQ V 2-0 1 by L,0,2-425rf &-Lz%--1 tQ- b thAf_L-e< ALt_r.�
(Signature of Notary) (Signature of Rbtnty)
KPersonally Known OR PXTRICY,Pic" �Npersonally Known OR P A26
Produced Identification 42�P% A 37 1 Produced Identificati GG 137
4P 11 .+ #r A5,NZA 5
Type of Identification: Type of Identification: EYI;Ars
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Doc # 2019137836, OR BK 18826 Page 779, Number Pages: 1,
Recorded 06/12/2019 04 :20 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10. 00
P-ermli �r- t2 C-sli - o , $)z-OFFICE COPY
NOTICE OF COMMENCEMENT
State of TaxFolioNo.
County of
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: L 114 &AgIdA 1, Ow JT J;2–13 —
Address of property being improved: M/ 9 r–L-32.243
General description of improvements: AA74o2vaAl,
iQ,9A44C4_ an-7-70A-J, +04j.4,j,6–&AJ 60 - -7 - e&
W41) _<74A
Owner: 4naeoue_ )8JQ4k)'9_11 Address: i &
Owner's interest in site of the improvement: 119,1111LINCALC-01
Fee Simple Titleholder(if other than owner):
Name: 021A
ontractor: .1091/21!C1 6_1
Address: j1a,j,5,1 &J, :;3�044a5 A2.
TelephoneNo.: Fax No: Alva:
Surety(if any) 4VA
Address: Amount of Bond$
Telephofi6 No: Pax NO:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may
be served:Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:.
Address:
Telephone No: Fax No:
Expiration date Of Notice of Commencement(the expiration date is one(1)year from the date-of recording unless a different date Is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Sign Date:
Bef;rre.me thl y of
Jay of -te
in the Covro`of DuZ,Sta
Of Florida,has personally appeared L e&J'Z*5�11,96 Lip
Notary Public at Large,State of Florida,County of Duval.
My commission expires: 41&97� &ftP70
Personally Known: -le: or
cluced I*M*RqNR--
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